The Creation Of My Hollywood Smile

Well, sorry folks, it’s been a while. Yet again I have been off globetrotting with scant, if any, regard for my blog; so my apologies that my updates have been rather thin on the ground lately. The good news is that I have been merrily collecting tips for travelling with Invisalign whilst on holiday – or rather, what not to do as the case turned out.

It all started so well. I had remembered to carefully pack an extra wash bag filled with all of the Invisalign supplies that I might need on holiday- the sterilising tablets, the floss, the emergency Colgate Wisps, the spare toothbrushes- you get the picture. I had also packed a tiny version in my carry on bag containing everything I might need to get me through the trials of a 24 hour flight from Australia to the Uk. Brushing your teeth in plane toilets is one of the joys that everyone should try to avoid as much as possible, so my plan was to abandon all pretence of wearing my Invisalign for 22 hours on the flight, try to manage about 16 hours, and hope for the best.

With all of the scurrying about, last minute emptying of the fridge, frantic unpacking and repacking of children’s cases to search for missing toys in response to tear stained pleas that a month long trip entails, I didn’t have time to have breakfast before leaving for our 8am flight. So, as is my usual style I whipped out my Invisalign, grabbed a snack bar and a nutritious bottle of diet coke (I know, I know) and headed out to the taxi clutching passports, drink bottles, favourite teddy bears and a thousand other bits and bobs in my clammy, overspilling hands.

Travelling with Invisalign – pack your aligners!

Thirty minutes later we were at the airport, bags checked in, feeling surprisingly calm and organised when I suddenly remembered that my Invisalign weren’t in my mouth. After two minutes of frantic rifling I realised, with a leaden stomach, that they were neither in my handbag or my carry on bag. That left two options; they were either in a checked in packed suitcase, or sitting nonchalently at home on the top of my coffee machine. Of course, whilst I had packed the lower aligners that I needed to change to in a fortnight, I had forgotten to pack my previous set as a back up and as the top aligners were my last ones in the series. This meant If I didn’t find them I would have no upper braces for a month.

Two minutes later I was back in a cab, hyperventilating and begging the poor bewildered driver to speed through suburban Brisbane to get back to my house as fast as possible. At this point I knew that it was a round trip of about an hour from airport to my house and that it was about an hour and twenty minutes until my 24 hour, non refundable flight took off, with or without me.

Fortunately, my taxi driver rose to the occasion admirably, his foot never leaving the floor, and seat belt burns not withstanding, we made it to my house in around 22 minutes, a record. Of course, after a frantic two minute search which included a quick scan of all the most likely places that I dump my braces I simply could not find them. Anywhere. I ran from room to room becoming increasingly hysterical and much to taxi drivers amusement even ran back out into the garden and began foraging through the dustbin in an attempt to find them. Finally, after about six frantic minutes I came to the conclusion that they must be in my checked in bags, grabbed the previous sets from a drawer to wear on the journey and flew back into the taxi to start another hair raising grand prix back to the airport.

We made the flight. Just. By the skin of our teeth.

Travelling with Invisalign – brushing in the plane toilet is not an experience to be savoured!

Of course, it was the usual joy on board of the rigmarole of 24 hours of putting in aligners, being offered a drink, removing aligners, drinking, squeezing past other passengers,queuingg for toilets, attempting to brush teeth in the fist sized, stained sink, returning to seat, five minutes later being offered food, removing aligners….you get the picture. Invisalign on planes are hard even if you aren’t squeezing your teeth into the previous set that you had stopped wearing a week ago. I don’t think I managed to wear them more than about 12 hours out of the 24, and even that was fraught with inconvenience.

It took me 24 hours after we arrived to get over my jet lag sufficiently to launch the search through our 90 kilos of luggage for my set six aligners. Despite checking the fifteen thousand small suitcase pockets, every washbag, the ten thousand pencil cases that my children deem necessary for a months holiday, they simply weren’t there.

Stuck in the Uk, on the other side of the world from my orthodontist, we had extensive email discussions back and forth about what exactly I could do to get my teeth from set 5 top and bottom that I was currently wearing, into the set 8 lower that I had in my bag. In all of the palaver, I had also forgotten set 7. Yes, I really am that stupid. I was astonished to be told that replacements would cost me $600. Gulp. Not only a stupid mistake but a costly one too.

So, to avoid the $600, with a little encouragement, some panadol, and a surprising amount of brute force, I actually managed to move my teeth from set 5 lower, to set 8 lower, skipping two whole sets.This incidentally is really not advisable except in dire emergencies. Hell, they were tight. There were moments, trying to force them onto my teeth where I wasn’t sure whether my teeth or the aligners would break first, but nonetheless, they went in in the end.

My instructions from my orthodontist were then to wear set 8 for three weeks before moving onto set 9 as normal. In the meantime, to also wear set 5 upper as retainers.

Home safe and sound I am still waiting for my orthodontists appointment to find out the damage I have done to my treatment. To this day, having looked through my whole house, I have no idea where set six went- only that they are gone, and it appears gone for good.

So, tip #1 for travelling with Invisalign. Remember to take them with you….

My eldest daughter, being something of a geek like her mother, has a copy of the Guinness Book Of Records that she likes to leaf through every now and then. Nothing gives her more joy than the knowledge of who can eat the most doughnuts in two minutes, or which is the largest island in the world (Greenland, incidentally.) So, imagine how thrilled she will be next year when she sees my new entry as the person with the most Invisalign aligners EVER!

Longtime readers will know that my first run of Invisalign were 17 Uppers and 34 Lowers, which I breezed through with very little actual trouble despite my frequent whining. The last few weeks I have been patiently awaiting the arrival of my refinements, enjoying the newfound freedom to snack myself out of being able to do up my favourite jeans.

Whilst my upper teeth are almost perfectly straight now and just need a couple of tiny tweaks with these refinements, my lower teeth still have a long, long way to go. In particular there is one tooth that is growing across the bottom of my mouth that I have always known will be a problem to move. My orthodontist reminded me again today that there are no guarantees that it will move at all, it may in fact be somehow fused to the bone which could be the reason that it proved impossible to remove when my dentist tried to pull it out. I have a good feeling about it though. Call me an optimist, or feel free to call me a fool if you prefer, but I think it will move with the Invisalign. I have included a picture of it below in all its revolting glory. The squeamish amongst you should look away now.

At the beginning of my treatment my orthodontist explained to me that the plan for my teeth is that we should open up a gap in the bottom row to make room for my stray tooth with the first run of aligners, then with a set of refinements (another series of aligners), or if necessary some metal braces, pull it up into the gap.

Having completed my first run of 34 lower aligners to open the gap I thought that I would have a similar number or slightly less aligners to pull the wayward tooth into line. I imagined that the hard bit was over, and from here on it it would just be a case of gently nudging the stray tooth into its shiny new space.

Lord, was I wrong.

Not only do I have more aligners than on the first run, I have 54 new lower aligners, something that my orthodontist tells me is a new record, for his practice at least! Adding those to my original 34 means that my lower teeth will take 88 Invisalign aligners in total- presuming I don’t need another refinement!!

At this point, just for the new readers amongst you I would like to make one thing clear. I have an extremely complex Invisalign case. I knew that from the outset; my orthodontist made it very clear from the beginning of my Invisalign treatment that my case wouldn’t be easy and that if it all worked as he hoped that he would write a paper on it for the Invisalign medical journals. By contrast I believe the average Invisalign case takes a year or less, some people with very simple cases taking well under six months. To give this thing perspective I was quoted 2-3 years in metal braces by other orthodontists that I saw, which probably means that my Invisalign will work out to about the same timeframe when all is said and done. So please, don’t let the length of my Invisalign treatment put you off, if anything I think my teeth just go to show how much can be achieved with Invisalign even in such complex cases.

Of course, as with anything there is good news and bad news here. The great news is that my top teeth need only 6 more aligners and I’m pretty certain given where we now are that they will be pretty perfect at the end of that time. Realistically, these teeth are all I care about. In six aligners time (or less than three months) I will have great teeth to all intents and purposes, as the things going on with my lower teeth are things that aren’t actually visible and will not have much impact on how good or otherwise my teeth look to the casual observer. Below is a picture of my upper teeth before Invisalign in Dec 2008(on the left) and as they are now before my second refinements June 2010 (on the right). After these six aligners I will also change the ugly discoloured crown that you can see on the left next to my upper front teeth. I think at the moment that crown is actually one of the things preventing my upper teeth from looking as good as they can do, changing it for a new, whiter better fitting one should make a huge difference.

Fortunately I can say in all truthfulness that the number of extra aligners really doesn’t bother me too much. My orthodontist told me not to even ask how many more I have so fearful was he of my reaction. Still, there was a definite look of relief that washed over his face when I burst into peals of laughter as I peered intently at the little plastic bags that hold your Invisalign and tell you how many aligners are included in your treatment. The truth is I would much rather wear Invisalign for a bit longer and get a good result than wear them for less time and the final result not be so good. Of course, the bad news for my orthodontist is that he now has to put up with me for a lot longer, so maybe it wasn’t relief washing over his face after all!

After six more aligners I will have to wear only the bottom trays anyway, which as far as I am concerned are almost completely invisible. As I have said before wearing only lower aligners is really not very different than wearing no aligners. I tend to forget that I have them rather than be bothered by them.

One thing that I have realised however is that with a run of 54 aligners I will have to be fastidious about wearing them 22 hours a day if I want to keep them fitting perfectly right up until the end. I have struggled in the past to be as diligent as I should be as those of you that have read my post about a typical day with Invisalign are probably aware. This has meant that occasionally there have been tiny gaps between my aligners and my teeth -although fortunately they have never been enough to worry about or to impact on my treatment. My new resolution therefore is that not only will I wear them 22 hours a day I will no longer pop them in and out of my mouth all day to feast on diet coke and mini muffins as I have been wont to do in the past.. That way I not only will I have great teeth but I might also finally lose the “Christmas weight” that I have been carrying around for the last six months! Perfect teeth and perfectly fitting jeans? My husband might not recognise me!

Incidentally, if you actually have more aligners than me please let me know via the comments form. You can get to it by clicking on the the little black speech bubble at the top of this entry that tells you how many comments there are. I would love to know who the person with the ACTUAL record for the most aligners is. Is can’t really be me, can it?

I don’t know whether it was because of a little over exuberance in removing my latest aligner, brought on by the thrill of being so close to the end of treatment (tray 31/34), or if it was the result of a few too many “adjustments” to my tray with a nail file, but I have managed to crack my #31 Invisalign tray.

Long time readers will remember that there have been a couple of occasions, particularly earlier in my treatment, where I had very slightly cracked one of my Invisalign aligners. Fortunately after a quick consultation with my Orthodontist it was decided that there was no harm done and I could keep wearing them. This time things were just a little more spectacular. Rather than a hairline crack as my previous ones have been, this aligner is split so that one part of it hangs limply from the other like a floppy, broken limb.

At the moment all the focus of my bottom tray is on opening up a gap sufficiently wide to allow my wayward tooth to move into it. This means that each tray shows a big change from the last one and it has been a struggle to get each new aligner in over the teeth that are moving the most. The aligner also has a slim piece of plastic now at this point rather than a tooth hole, and it is here that it cracked.

As it was number 31 that cracked and I am so close to the end of treatment, my immediate hope was that I could put in tray 32, perhaps wear it for a little longer, and still complete treatment as scheduled. My teeth had other ideas.

A cursory examination of set 32 showed that it was significantly different from set 31- so much so that it was hard to believe the change from one to another. So I knew that it would be a struggle- particularly as I had cracked #31 the first time that I wore it. Still, I was determined, and fairly sure I could get the tray in, one way or another.

Set 32- the unbroken aligner!

After about 2 frustrating minutes of huffing, puffing, wriggling and generally trying to jam my teeth into set 32 I realised that it wasn’t going to be easy. A closer inspection showed that there was a fundamental problem. One of the movements that set 31 must have been designed to achieve was to rotate the lower tooth next to the gap. Whilst this might have not made much difference if the tooth in question did not have an attachment, with an Invisalign button in place it meant that the bubble on the aligner to fit on the attachment was nowhere near the attachment itself. There was simply no way of fitting the aligner onto my tooth.

To cut a long story and a little telephone tag short, after a rather frantic call on my part, my orthodontist called me back to tell me that he has decided that rather than ordering a new #31 aligner- which could take some time given that we are in Australia- he will simply do a refinement to get my teeth to where we want them to be. We are so close to almost finishing this run, and he already knew that refinements would be necessary, that he has decided on balance that this is the best course. This will also allow him to look at the problem of widening both my arches further and so will hopefully solve two issues in one fell swoop.

The only delay now is that I need to wait for my orthodontist to have a long appointment free so that he can take more impressions of my teeth as they are now. He doesn’t have any for two weeks which means that in the meantime I need to wear set #30 lower for 22 hours a day and set #9 upper of my refinements as a retainer at night. This is fine, other than that sometimes it is hard to remember to put the lower one back in after eating, without the upper one needed too.

Nonetheless, I am happy to say that after my initial angst I am not too concerned about this temporary hiccup. I think it may turn out not to delay my treatment too much in the end, and might actually move me towards getting my upper arch perfect more quickly. No doubt it is all part of life’s rich Invisalign journey! Onwards and upwards..

One of the topics that I get more questions about than any other on this blog is finding an Invisalign dentist or orthodontist. My own search for an Invisalign dentist or orthodontist took visits to several providers before I was able to find someone that I liked that was willing and able to treat me.

Invisalign dentist or orthodontist. Does it matter?

One of the things that surprises me the most when I am asked this is that many people don’t understand the difference between a dentist and an orthodontist. The easiest way to explain it is to compare it to doctors. A dentist is the equivalent of a GP. They do general dentistry; sometimes this includes some orthodontics. In many countries they aren’t allowed to call themselves orthodontists but get around this by using the word “orthodontics” or similar in their advertising. By comparison an orthodontist is like a specialist doctor such as a cardiologist, except that they specialise in the movement of teeth. In most countries orthodontists have done substantial additional study at university (often several years) and generally do nothing but orthodontic work in their practices.

Invisalign is available through both dentists and orthodontists. Rather than having substantial orthodontic training, Invisalign providers are required to do an Invisalign course before they can offer Invisalign. It had never occurred to me to wonder exactly how extensive or otherwise this Invisalign training was.

Recently however, I was having a quick google to find some piece of Invisalign information or another and came across the following post from a dentist who is no longer offering Invisalign. To be honest, it terrified me.

As an avid reader of Invisalign forums I had known that Align (the makers of Invisalign) had been tightening up their systems to ensure that only more experienced providers of Invisalign kept offering it, but frankly what I read on the dentists blog terrified me.

For instance her assertion that she took a two day course to qualify in Invisalign and that:

“I graduated Temple dental in 2001 with little clue how to successfully and orthodontically move a tooth. Like most clinicians, I learned little about orthodontics in dental school. Sure I bent some wires, took a gazillion alginates, uprighted some molars, and occasionally made an active or passive appliance. Requirements, however, were minimal and Ortho at Temple was always the ‘easy A.’”

must surely be a worry for people that are considering Invisalign through a general dentist.

Similarly I don’t know whether there is any truth in her statement:

“Invisalign approved nearly any case you sent. Even with unpredictable movements like extrusions, intrusions, rotations and difficult cases like open bites and cross-bites, Invisalign provided a successful clincheck. This of course was nonsense and after a few poor results, I quickly learned Invisalign’s limitations.”

but it certainly makes me glad that Align are tightening their policies. (incidentally, I wonder whether this blanket approval theory is still true; my orthodontist who is VERY experienced tells me that he gets cases refused regularly that he thinks he could treat)

All in all I think anyone who is interested in Invisalign should read this dentists post to make sure that they ask the right questions before choosing their provider.

As someone with a very complex case my preference for me is an orthodontist to do my treatment. However, I know that many, many people have had dentists do their Invisalign and they have done a fantastic job. The key to it seems to be that you absolutely have to ensure that your provider has experience of using Invisalign and lots of it and you should keep this foremost in your mind when choosing an Invisaling dentist or orthodontist. Fortunately, the Invisalign website ranks providers according to the number of cases they have undertaken recently. Still, it never hurts to ask the question yourself. I saw one provider who had not finished a single Invisalign case but was happy to take on my very complex issue. I would also point out that I think it is important to ask not only how many cases have been treated but also whether any cases similar to yours have been completed and how successful the results were. Ask to see before and after pictures where possible as these will tell you whether you would have been happy with the treatment.

Also, I think when deciding who to go with that it’s important to not just base your decision on what Invisalign costs from each provider. Certainly, if you have a very straightforward simple orthodontic issue you will probably find that you get a great result whoever does your treatment. If however, you have anything more complex you really need to consider who will be the best person to treat you. I know that many patients ring around hoping to get the best price- who doesn’t want to pay as little as possible? In more complex cases though, I think it is also vital that you take into account whether the cheapest provider is actually the best one for you in experience terms. Of course, that isn’t to say that more expensive means more experience- I often found the reverse to be true. Rather I just mean that experience should be just as, if not more, important than price in complex cases.

I intended to follow the old English saying “start as you mean to go on” this year with my Invisalign Braces. So far, not so good.

In fact, not only did I pass midnight on New Year’s Eve without my braces in my mouth, I woke up with them on my bedside table on January the first. Not a great start.

This is actually a first for me. Although I am generally pretty poor in complying with the 22 hours a day Invisalign requirement (I average more like 20ish I think) I have never, ever left my aligners out overnight before! In fact, I’ve never even come close. Whilst I confess that I had consumed rather more alcohol than I might normally and that might have had something to do with it I am still amazed that I managed to go to bed and sleep the whole night (well, OK 1am to 9am!) without realising that something was missing. It took me less than 30 seconds to work out that my aligners weren’t in when I woke up, and a quick glance at my bedside table confirmed what I had suspected. Nonetheless despite my pounding head and the waves of nausea that let me know that I had drunk more than I have in many, many years I was still surprised that I had been drunk enough to forget my braces. I had thought that I was on autopilot these days when it comes to putting them in before bed. Obviously not!

I visited my orthodontist this week for my regular six weekly appointment and in a fit of raging guilt told him that I had a confession to make. He stood there, eyebrows raised expectantly with an expression I haven’t seen anybody wear since I left school, whilst I nervously weighed up whether or not to admit the whole sorry truth. However, I needn’t have worried. After admitting that I had left my braces out for a whole night he did nothing but snort, give a dismissive guffaw and tell me “That’s not a confession!” Apparently the girl in before me had left hers out for several days over Christmas and had to go back two aligners just to get them back in her mouth. So I picked the right time to confess I guess!

Despite me being so remiss all seems to be going reasonably well. I had 9 upper refinements (on top of my original 17 aligners) which consisted of 6 refinements and 3 over-corrections. I have now completed my first 6 refinements and I think there is still a little way to go before my teeth are absolutely finished on the top. My orthodontist told me that this is fairly standard; in fact most people who need refinements need to use the over-corrections. Over-corrections are given by Invisalign because those particular teeth proved stubborn to move the first time around and apparently they then usually remain resistant throughout treatment. For this reason he has told me to wear my next two upper over-corrections and he will then review my teeth again to see whether we are satisfied with the final positioning.

My bottom arch is now on aligner 26/34 and whilst I can see great progress my orthodontist is not convinced that there will be sufficient room after another 8 aligners to get my bottom wonky tooth (which you can see here on my clincheck) in to place. I am cautiously hopeful that he is wrong, but we shall see. If there isn’t enough room by number 34 we will have to do refinements (additional aligners) for the bottom row too. Funnily enough on my clincheck it always looked like there would be plenty of room long before the end and as my teeth seem to be tracking perfectly I am surprised that there isn’t. As my orthodontist has told me repeatedly the clincheck is only a guide, not gospel. Having read numerous other patients Invisalign stories I know that that is the truth. It seems that it doesn’t pay to get too wedded to the final result that the clincheck shows, it’s a useful estimate but nothing more.

There is no massive progress since the last Invisalign pictures that I posted ( you can see the highlights in the sidebar on the right) so I won’t post more now, but I’ll take more after these two over-correction uppers so you can give me your verdict on my upper arch. I think that I could do with a little more widening of my molars, but maybe the over-corrections will take care of that, we shall see. In the meantime I intend to try and make up for the misdemeanours of New Year’s Eve by being especially compliant in January. We shall see how long that lasts! At the very least I am happy that one year into treatment I am still loving my Invisalign.. Watch this space!

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